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Biomedical subjects

F Couturaud

Publications and source records attributed to F Couturaud.

18 recordsLinked to original sources
PubMed2006

Diagnosis and management of subsegmental pulmonary embolism.

INTRODUCTION: Although the advent of multi-detector row computed tomography (CT) has enabled better visualization of subsegmental pulmonary (SSP) arteries, SSP embolism is of uncertain clinical significance. We aimed at answering the following questions: Is spiral CT an accurate method to detect SSP embolism? How are subsegmental perfusion defects managed in outcome studies including spiral CT? What are the main characteristics and outcomes of patients in whom CT detects isolated subsegmental defects? METHODS: We performed a Medline search on July 1, 2004, using the keywords 'pulmonary embolism' and 'computed tomography'. We limited our search to English language prospective studies comparing CT to pulmonary angiography, and to prospective outcome studies including CT in a diagnostic strategy, with at least a 3-month follow-up. RESULTS: Fourteen studies comparing CT to pulmonary angiography, and five prospective management studies using CT were retrieved. The sensitivity of single-detector CT for detecting subsegmental defects compared with pulmonary angiography was low (25%). The proportion of isolated SSP images was significantly higher in management studies using multi-detector CT (17 of 770 scans, 2.2%) compared with those using single-detector CT (22 of 2232, 1.0%; P = 0.01). No straightforward attitude regarding anticoagulation therapy for isolated subsegmental defects emerged from the available literature. Finally, important clinical differences were found between patients having subsegmental and segmental or more proximal defects. CONCLUSIONS: These findings underline the uncertainty regarding the clinical significance of SSP embolism, and the management of patients with such findings.

Angiography↗
PubMed2006

Hyperhomocysteinemia and low B vitamin levels are independently associated with venous thromboembolism: results from the EDITH study: a hospital-based case-control study.

BACKGROUND: Moderate hyperhomocysteinemia and B vitamins deficiency are thought to be risk factors for venous thromboembolism (VTE). The causality and independence of those associations are still questioned. METHODS: We measured fasting serum total homocysteine, folates, and vitamin B12 levels as well as 5,10-methylenetetrahydrofolate reductase (MTHFR) C677T genotypes in 467 patients hospitalized with a first well-documented deep vein thrombosis and/or pulmonary embolism not related to a major acquired risk factor and 467 controls matched for gender and age. RESULTS: Mild hyperhomocysteinemia, low serum folates, and vitamin B12 were associated with VTE independently of each other. In multivariate analysis, odds ratios (OR) (95% CI) for VTE associated with mild hyperhomocysteinemia (>15 micromol L(-1)), low serum folates (< or = 4.9 nmol L(-1)), and vitamin B12 (< or = 253 pmol L(-1)) were 1.48 (1.05-2.08), 3.14 (1.35-7.32) and 1.42 (1.03-1.98), respectively. An MTHFRC677T genotype was not significantly associated with VTE; OR (95% CI): 1.13 (0.70-1.81) CONCLUSIONS: The current data provides further knowledge in the complex relationship between hyperhomocysteinemia, low vitamin levels, and VTE.

Adolescent↗
PubMed2004

Chlamydia pneumoniae IgG serological status and venous thromboembolism: a cross-sectional hospital based study.

OBJECTIVE: To search for a link between Chlamydia pneumoniae serological status and venous thromboembolic disease. METHODS: From March 1992 to October 1999, we conducted a cross-sectional hospital-based study of consecutive unselected outpatients referred to us for clinical suspicion of venous thromboembolism. We compared the Chlamydia pneumoniae serological status with respectively, the venous thromboembolism, the deep vein thrombosis and the proximal deep vein thrombosis status. RESULTS: Among 1193 patients registered for suspected venous thromboembolism, 1010 samples were available (499 negative and 511 positive patients for venous thromboembolism). Seventy-nine patients were Chlamydia pneumoniae positive. Our work failed to demonstrate any clear association between Chlamydia pneumoniae and venous thromboembolism status. Nevertheless, we identified a statistical difference regarding Chlamydia pneumoniae seropositivity and proximal vein thrombosis status (adjusted odds ratio of 1.70, CI95%: 1.05 to 2.77). CONCLUSION: The presence of Chlamydia pneumoniae antibodies might be a minor risk factor for venous thrombosis.

Aged↗
PubMed2002

Education and self-management: a one-year randomized trial in stable adult asthmatic patients.

OBJECTIVE: to assess the effects of an educational program in asthmatic patients, following treatment readjustment. METHODS: moderate to severe asthmatic adults underwent a run-in period (up to 45 days) in order to optimize their treatment. Patients were then randomized to an educational or control group over a one-year period. Education consisted of five individual sessions covering: pathophysiology of asthma, role of medication and side-effects, asthma triggers and their avoidance, detection of an asthma flare-up, and self-management plan based on symptoms and peak-flow monitoring. MAIN OUTCOME CRITERION: symptom-free days over the study period (SFD). RESULTS: a total of 72 patients were enrolled (36 in the "education group" and 36 in the "control group"), 54 of whom completed the study. Mean SFD was comparable in the two groups (88% in the education group and 89% in the control group, respectively). When the analysis was restricted to the education group, those patients who complied perfectly with the action plan (n = 5) exhibited a higher SFD, compared to the others (97% vs. 87%, p = 0.009). CONCLUSION: both education and control groups showed high and comparable percentages of SFD. Compliance with self-management plans appears to be an important determining factor in educational programs.

Adolescent↗
PubMed2002

Decrease in sensitivity of D-dimer for acute venous thromboembolism after starting anticoagulant therapy.

D-dimer testing is useful for the exclusion of acute venous thromboembolism (VTE). Anticoagulant therapy is expected to reduce D-dimer levels in patients with thrombosis and, consequently, it may not be safe to use D-dimer levels to exclude VTE after anticoagulant therapy has been started. The objectives of this study were to estimate the decrease in D-dimer levels after 24 h of heparin therapy and, applying this estimate to the results of a recent study, to calculate the expected reduction in sensitivity. Using pre-defined criteria, we first performed a literature review to determine whether, and by how much, D-dimer levels decrease within 24 h of starting heparin therapy in patients with acute VTE. Using D-dimer levels that were measured in a prospective study of patients with confirmed deep vein thrombosis and/or pulmonary embolism as baselines, we then determined the change in sensitivity (and specificity) that would result from the fall in D-dimer levels that the literature review suggested would have occurred after 24 h of heparin therapy. On the basis of the literature review, we calculated that mean D-dimer levels decrease by 25%, 24 h after starting heparin therapy in patients with acute VTE. This 25% decrease in D-dimer levels resulted in a decrease in sensitivity from 95.6% (95% confidence interval, 90.0-98.6) to 89.4% (95% confidence interval, 83.7-95.1). There is a decrease in D-dimer levels in patients with acute VTE 24 h after starting heparin therapy that is expected to result in a clinically important drop in sensitivity.

Adult↗
PubMed2001

Treatment of deep vein thrombosis.

Most patients who present with deep vein thrombosis (DVT) can be treated with weight-adjusted, fixed-dose, low molecular heparin as an outpatient. The subsequent duration of oral anticoagulant therapy should be individualized according to the risk of recurrent venous thromboembolism and the risk of anticoagulant-induced bleeding. The risk of recurrence is low if thrombosis was provoked by a major reversible risk factor such as surgery; 3 months of treatment is usually adequate for such patients. The risk of recurrence is high if thrombosis was unprovoked ("idiopathic") or associated with a nonreversible risk factor such as active cancer; at least 6 months, and sometimes indefinite, anticoagulant therapy is indicated for such patients. The presence of an antiphospholipid antibody, and other selected thrombophilic states, favors more prolonged therapy within each of the categories noted previously. Systemic thrombolytic therapy helps to restore venous patency and probably reduces the risk of the postthrombotic syndrome; however, it is associated with an unacceptable risk of bleeding. Catheter-directed thromboylsis, particularly for isolated iliofemoral thrombosis, may be beneficial and needs further evaluation in controlled trials.

Algorithms↗
PubMed2001

[Hypersensitivity pneumonitis in a patient taking pravastatin].

A 41-year-old man who had been taking pravastatin for two years developed hypersensitivity pneumonitis. The initial examination found intestinal pneumonitis and hypereosinophilia. The patient's syndromes gradually resolved with withdrawal of pravastatin. As HMG coenzyme A reductase inhibitors are commonly prescribed, any respiratory symptoms in this setting should be considered with special attention.

Adult↗
PubMed2001

Low molecular weight heparin administered once versus twice daily in patients with venous thromboembolism: a meta-analysis.

BACKGROUND: Low molecular weight heparin is as effective and safe as unfractionated heparin for treatment of acute venous thromboembolism. It is uncertain whether low molecular weight heparin should be administered once-daily or twice-daily in this setting. METHOD: A meta-analysis of randomized studies which directly compared once- and twice-daily administration of low molecular weight heparin for the treatment of acute venous thromboembolism was performed. A literature search was performed using Advanced Pub Med and the Cochrane library database, and abstracts from recent meetings were reviewed. Two investigators extracted data independently. RESULTS: Five studies, involving 1522 patients, were eligible. There were no statistically significant differences in the frequencies of symptomatic (odds ratio, 0.85 in favor of once-daily therapy at three months, p = 0.6), and asymptomatic, recurrent venous thromboembolism, total and major bleeds (odds ratio, 1.16 in favor of twice-daily therapy at 10 days, p = 0.8); and death, at 10 days, as well as at three months of follow-up. CONCLUSION: Once-daily low molecular weight heparin appears to be as effective and safe as twice-daily administration for the acute treatment of venous thromboembolism. However, there is inadequate data from studies that directly compared once-daily and twice-daily administration to be able to exclude the possibility of a higher frequency of fatal bleeding with once-daily therapy.

Acute Disease↗
PubMed2000

Long-term treatment for venous thromboembolism.

Anticoagulation is the corner stone of therapy for venous thromboembolism. The optimal duration of this therapy depends on the balance between the risk of recurrent thrombosis if anticoagulants are stopped, and the risk of bleeding if patients remain on treatment. The risk of recurrence is low if thrombosis was precipitated by a major reversible risk factor such as surgery. Patients with idiopathic thrombosis (no apparent risk factor) and those with persistent risk factors (eg, cancer), have a high risk of recurrence. Some hereditary (eg, protein C, protein S or antithrombin deficiency; homozygous factor V Leiden) and acquired (eg, antiphospholipid antibodies) thrombophilic states are also risk factors for recurrence. Three months of anticoagulation is recommended when the risk of recurrence is low, whereas the duration of therapy should be extended to 6 months or longer when this risk is high, depending on the balance between the risk of recurrence and the risk of bleeding in each individual patient. Heparin preparations, at doses intermediate to those used for the acute treatment of venous thromboembolism and for primary prophylaxis, are an alternative to oral anticoagulants during the maintenance phase of treatment.

Anticoagulants↗
PubMed2000

Methylenetetrahydrofolate reductase C677T genotype and venous thromboembolic disease.

BACKGROUND: Many studies have suggested an increased risk of venous thromboembolism (VTE) in patients with mild hyperhomocysteinemia. The C677T mutation in the MTHFR gene has recently been described as a cause of mild hyperhomocysteinemia. OBJECTIVES: To investigate the potential of the C677T mutation in the MTHFR gene in its homozygous state as a risk factor for VTE. METHODS: Case-control study design. The presence of the mutation was determined in all consecutive patients referred from July 1994 to September 1997 and in whom the diagnosis was duly confirmed. Analysis was carried out in a subgroup of VTE patients free from both acquired and genetic risk factors (factor-V mutation and/or prothrombin gene mutation). A control group consisted of 105 volunteer blood donors. RESULTS: In the 366 patients with a confirmed VTE, 253 presented acquired risk factors and 58 were carriers of the factor-V Leiden mutation and/or G20210A mutation of the prothrombin gene. In the remaining 55 patients, VTE was considered as 'unexplained', and the frequency of the C677T mutation MTHFR was 21.8% in its homozygous state and 34.5% in its heterozygous state. In the control group, 9.5% were found homozygous and 34.3% heterozygous. The odds ratio for having VTE in the presence of the mutation in its homozygous state was 2.9 (95% CI 1. 0-8.6). CONCLUSION: This study suggests that the homozygous C677T mutation in the MTHFR gene might be a risk factor of VTE in patients with spontaneous events and without other common genetic risk factors.

Adolescent↗
PubMed1996

[Prevention of deep venous thrombosis in medical care].

Venous thromboembolism is a frequent and potentially severe ailment in medical patients; the clinical signs are unreliable and as early detection of the thrombosis process by non-invasive techniques is not available, prevention appears to be an alternative. Careful definition of the medical situations at risk from venous thromboembolism is necessary. Age, prior history of venous thromboembolism, and immobilization constitute high risk circumstances. Analysis of the published studies advocates prevention in three circumstances: myocardial infarction, stroke and intensive care. In other cases, further controlled studies, randomized versus placebo, are needed.

Clinical Trials as Topic↗
PubMed1995

[Plastic bronchitis].

We report a case of plastic bronchitis occurring in a 58 year-old man free from underlying pulmonary disease. Relief of symptoms was observed under steroid therapy (1 mg/kg), but relapse occurred as treatment being tapered. Such evolution is in accordance with recent published data.

Bronchitis↗
PubMedDate not supplied

Assessment of the risk and prophylactic treatment of venous thromboembolism in the elderly.

Numerous large randomized controlled trials have assessed the benefit of prophylactic anticoagulation for venous thromboembolism in selected patients. However, few trials were conducted in elderly patients, as this issue was not addressed in this specific population,or as elderly patients were excluded of these studies. Therefore, as the risk of a first episode of venous thromboembolism (in surgical and in medical setting) and the risk of a major anticoagulant-related bleeding are both increased in elderly subjects, the results of the main available studies can not be extrapolated to this population. Consequently, in practice, the balance between expected benefit and risk of prophylactic anticoagulation should be carefully assessed for each individual elderly patient taking in account the specific risk of venous thromboembolism in elderly in the absence of anticoagulation, the risk of anticoagulant related bleeding according to the type of anticoagulant treatment and the intrinsic risk of bleeding of elderly subjects and, lastly, the available guideline recommendations. In order to improve such evaluation, it is anticipated that further prophylactic studies are needed in elderly patients. In addition, the development of anticoagulation clinics and new oral anticoagulants should help to reduce anticoagulant related bleeding for an equivalent, or an increased, benefit.

Aged↗
PubMedDate not supplied

[Optimal duration of anticoagulant treatment of venous thromboembolism].

RECURRENT THROMBOSIS VERSUS ANTICOAGULANT-RELATED BLEEDING: The optimal duration of anticoagulation for venous thromboembolism depends on the balance between the risk of thrombosis if anticoagulation is stopped, and the risk of bleeding if patients remain on treatment. In the past decade, five large well designed trials have been completed which have compared different durations of anticoagulation for the treatment of various categories of patients with venous thrombosis. In conjunction with the findings of a number of other prospective studies, these trials have helped to identify risk factors for recurrent venous thrombosis and anticoagulant-related bleeding, and have led to a better understanding of the optimal duration of therapy for individual patients. RISK OF RECURRENT THROMBOSIS: The risk of recurrent thrombosis is low if thrombosis was precipitated by a major reversible risk factor such as surgery. Patients with idiopathic thrombosis (no apparent risk factor) and those with persistent risk factors (e.g., cancer), have a high risk of recurrence. Some hereditary (e.g., protein C, S or antithrombin deficiency) and acquired (e.g., antiphospholipid antibodies) thrombophilic states are risk factors for recurrence independently of whether thrombosis was, or was not, provoked by a major risk factor. DURATION OF THERAPY: Patients with a low risk of recurrence should be anticoagulated for three months. Others should be treated from 6 months to indefinitely, depending on the balance between the risk of recurrence and the risk of bleeding in each individual patient.

Anticoagulants↗
PubMedDate not supplied

[Anticoagulants in the elderly. Age-related factors].

HEPARINS: For unfractionated heparins, certain studies have demonstrated increased hemorrhage rates correlated with age and with renal function. Subcutaneous injections every 12 hours are as effective and less uncomfortable for the patient than continuous intravenous infusions. Low-molecular-weight heparins are currently contraindicated for curative treatment and their use is not recommended for prevention when the creatinine clearance is below 30 ml/min. OTHER ANTICOAGULANTS: The dosage of sodium daparanoid should be adapted to the renal function with regular surveillance of anti Xa activity. With hirudin, there is a risk of product accumulation in case of renal failure. For oral anticoagulants the relationship between old age and the frequency of hemorrhagic complications is still a subject of debate. ORAL ANTICOAGULANTS: The starting dosage should be reduced to one-half or one-quarter of the usual dose. The INR should be measured regularly, particularly since elderly subjects are highly susceptible to wide variations in INR irrespective of the cause. It is also advisable to carefully determine appropriate situations when oral coagulants should be used.

Age Factors↗
PubMedDate not supplied

[Anticoagulants in the elderly. Indications].

UNLABELLED: RISK AND BENEFIT: The beneficial effect of anticoagulant treatment is well established by numerous therapeutic trials demonstrating its usefulness in two main indications (venous thromboembolism and complete arrhythmia due to atrial fibrillation) in selected populations. Very few trials have been specifically conducted in elderly subjects and the increased risk of thrombosis and anticoagulant related bleeding cannot be used to extrapolate the results to elderly subjects. For this reason, a careful assessment of the initial risk and expected benefit must be made for each individual patient using a validated and systematic global evaluation system adapted for elderly subjects in order to better discern the indications and the risk of hemorrhage. PERSPECTIVES: The development of anticoagulation clinics, based on the method initiated by Professor Boneu at Toulouse, together with clinical trials designed to produce results transposable to the diverse and complex geriatric population, and finally the development of new oral compounds not requiring laboratory tests under the same conditions should help reduce the therapeutic risk for an equivalent benefit.

Age Factors↗